C. Pancreatic hemorrhage or trauma

tion of pharmacologic doses of steroids to reduce brain swelling, high rate infusions of glucose-containing solutions (especially in patients with diabetes insipidus), and increased sympathetic activity associated with brain injury. Hyperamylasemia is concerning but reports have indicated that it has no meaningful influence on pancreas graft function posttransplant. The cause of hyperamylasemia due to pancreatitis, or due to pancreatic injury in the case of a donor with trauma, will be ruled out at the time of procurement.

The hemodynamic stability and need for inotropic support is an important consideration. This has more influence on the anticipated function of the kidney allograft than it does on initial endocrine function of the pancreas allograft in the case of an SPK transplant.

Perhaps the most important determinant of the suitability of the pancreas for transplantation is by direct examination of the organ during the surgical procurement. The experience of the procurement team is important for correct assessment of the suitability of the pancreas graft for transplantation. It is during procurement that judgment regarding the degree of fibrosis, adipose tissue, and specific vascular anomalies can be accurately assessed. Pancreata with heavy infiltration of adipose tissue are believed to be relatively intolerant of cold preservation, and carry with it the potential of a high degree of saponification due to reperfusion pancreatitis that follows revascularization. These organs may be more suitable for islet isolation.

The important vascular anomaly that must be evaluated during procurement is the occurrence of a replaced or accessory right hepatic artery originating from the superior mesenteric artery (SMA). The presence of a replaced right hepatic artery is no longer an absolute contraindication for the use of the pancreas for transplantation. Experienced procurement teams will be able to successfully separate the liver and the pancreas either in-situ, or on the backbench, without sacrificing quality of either organ for transplantation.

However, there are a few important caveats that determine if this is possible. First, it is important to emphasize that the pancreas is not a life-saving organ. Therefore, the highest priority must be to ensure an acceptable vascular supply to the liver allograft. The replaced right hepatic artery needs to be dissected down to the SMA. If the replaced right hepatic artery traverses deep into the parenchyma

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